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HX64166147 
RJ496.P2  G76         A  note  on  the  presen 


RECAP 


Robert  Graham 


A  note  on  the  presence  of  B,  Botulinus 
T./p©  A  in  the  excretions  of  poliomyelitis 
patients • 


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Ii^1f6  f^ 


CotamWa  59nit)em'tp 

COLLEGE  OF 
PHYSICLANS  AND  SURGEONS 

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in  2010  with  funding  from 

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UNIVERSITY     OF     ILLINOIS     BULLETIN 


Vol  XIX 


ISSUED  WEEKLY 


October  17,  1921 


No.  7 


[Entered  as  aecond-class  matter  December  11,  1912,  at  the  post  office  at  Urbana,  Illinois,  under  the 
Act  of  Avigust  24,  1912.  Acceptance  for  mailing  at  the  special  rate  of  postage  provided  for  in 
section  1103,  Act  of  October  3,  1917,  authorized  July  31,  1918. J 


A  NOTE  ON  THE  PRESENCE  OF 

B.  BOTULINUS  TYPE  A  IN  THE  EXCRETIONS 

OF  POLIOMYELITIS  PATIENTS 


By  ROBERT  GRAHAM  and  EDGAR  BARGER 

Laboratory  of  Animal  Pathology  and  Hygiene 


PUBLISHED  BY  THE  UNIVERSITY  OF  ILLINOIS 
URBANA 


NOVEMBER  9,  1921 


A  NOTE  ON  THE  PRESENCE  OF 

B.  BOTULINUS  TYPE  A  IN  THE  EXCRETIONS 

OF  POLIOMYELITIS  PATIENTS 


By  ROBERT  GRAHAM  and  EDGAR  BARGER 
Laboratory  op  Animal  Pathology  and  Hygiene 


PUBLISHED  BY  THE  UNIVERSITY  OF  ILLINOIS 
URBANA 

NOVEMBER  9,  1921 


il 


-^       I     IY^> 


&n 


Epidemiologic  Map  I 
Outbreaks  of  Poliomyelitis  in  Illinois,  Jan 
1,  192/,  to  October  31,  1921.  Data  furnished 
by  State  Board  of  Health.  Total  number  of 
cases,  463.  Number  of  patients  from  which 
specimens  were  secured  by  the  Laboratory 
of  Animal  Pathology  and  Hygiene,  Univer- 
sity of  Illinois  (indicated  by  red  dots),  87. 
Single  circle  indicates  location  of  patients 
excretions  of  which  proved  positive.  Double 
circle  indicates  location  of  patients  excre- 
tions of  which  proved  positive  but  which  arc 
not  discussed  in  this  leaflet. 


A  NOTE  ON  THE  PRESENCE  OF  B.  BOTULINUS 

TYPE  A   IN  THE   EXCRETIONS  OF 

POLIOMYELITIS  PATIENTS 

By  EOBEET  graham  and  EDGAE  BAEGE'E, 
Laboratory  of  Animal  Pathology  and  Hygiene,  University  of  Illinois 

Thru  the  cooperation  of  health  officials,  hospitals,  and  practicing 
physicians  of  Illinois,^  specimens  of  excretions  from  children  suffering 
from  poliomyelitis  have  been  submitted  to  the  Laboratory  of  Animal 
Pathology  and  Hygiene  for  examination.  Sterile  containers  were 
mailed  to  the  attending  physician  and  the  samples  of  urine  and  feces 
as  collected  were  cultured  immediately  upon  arrival  at  the  laboratory. 
The  purpose  of  this  leaflet  is  to  record  the  presence  of  B.  botulinus 
type  A  in  one  feces  and  two  urines  of  children  during  the  convalescent 
period  of  a  poliomyelitis  infection.'  The  bacteriologic  studies  here 
reported  are  limited  to  samples  of  urine  and  feces  from  cases  diagnosed 
as  poliomyelitis. 

The  possibility  of  B.  botulinus  as  a  saprophytic  contaminant  of 
the  alimentary  tract  of  healthy  children  as  well  as  the  possibility  of 
this  microorganism  being  present  in  the  normal  genito-urinary  tract 
is  not  disregarded  in  the  preliminary  investigations.  Furthermore, 
the  method  employed  in  collecting  specimens  may  not  have  sufficed 
to  eliminate  extraneous  contamination.  In  any  event,  it  seems  a  note- 
worthy fact  that  B.  botulinus  should  be  encountered  in  excretions 
from  the  human  body,  and  even  tho  upon  further  study  it  should  be 
established  that  this  microorganism  bears  no  relation  to  the  neuro- 
tropic virus  of  poliomyelitis  or  an  analogous  symptom  complex  in 
children,  the  widespread  character  of  B.  botulinus  in  nature  will  be 
more  fully  understood. 

Poliomyelitis  as  an  investigational  problem  came  to  our  attention 
in  connection  with  studies  conducted  during  the  past  five  years  rela- 
tive to  the  etiologic  character  of  certain  obscure  toxemic  syndromes 
in  domestic  animals.     The  results  of  these  studies  have  shown  that 


^  Grateful  acknowledgment  is  hereby  made  for  the  helpfnl  cooperation  and 
assistance  given  by  the  Hlinois  State  and  Chicago  Boards  of  Health,  as  well  as  the 
Cook  County  and  Durand  Hospitals  of  Chicago,  Dr.  C.  W.  East,  Dr.  J.  J.  McShane, 
Dr.  C.  G.  Appelle,  Dr.  W.  E'.  Schowengerdt,  Dr.  Butler,  and  many  other  practi- 
tioners of  human  medicine. 

^  Since  this  report  was  written,  three  specimens  of  urine  (188,  242,  and  395) 
from  three  other  convalescent  cases  of  poliomyelitis  have  upon  bacteriologic  exam- 
ination revealed  the  presence  of  B.  botulinus  type  A.  The  geographic  locations  of 
these  three  cases  are  indicated  on  epidemiologic  MajJ  I  by  a  red  dot  surrounded  by 
two  circles. 


4  University  of  Illinois  Bulletin  '        [November  9, 

botulism  is  a  rather  common  disease  thruout  the  Mississippi  valley, 
affecting  swine,  chickens,  cattle,  sheep,  and  horses.  (See  Maps  III 
and  IV.)  Notwithstanding  the  fact  that  Flexner  and  others  working 
in  the  field  of  poliomyelitis  have  disregarded  the  possible  relation  be- 
tween spinal  paralysis  in  farm  animals  and  poliomyelitis  in  children, 
certain  clinical  and  epidemiologic  observations  in  animal  botulism  with 
special  reference  to  poliomyelitis  in  children  as  it  occurred  in  Illinois 
during  the  late  summer  months  of  1921  failed  to  clearly  and  decisively 
eliminate  the  possible  etiologic  connection  between  all  cases  of 
poliomyelitis  and  botulism  in  animals. 

A  knowledge  of  the  varying  symptoms  of  botulism  in  animals  sug- 
gested that  the  clinical  aspects  of  a  botulinus  intoxication  in  man 
might  also  vary  markedly.^  The  clinical  analogy  between  spontaneous 
botulism  in  nursing  lambs  as  it  occurred  in  Champaign  county,  Illi- 
nois (1917),  to  poliomyelitis  in  children  also  suggested  the  possibility 
of  a  common  etiologic  factor.  Furthermore,  the  resistance  of  the 
bovine  species  to  contaminated  rations  pointed  to  the  possible  danger 
of  milk  from  apparently  healthy  lactating  animals  consuming  con- 
taminated grains  and  hays.  Experimental  data  bearing  on  the  rela- 
tion of  B.  botulinus  and  toxin  in  the  feed  of  the  healthy  lactating 
animal  to  the  presence  of  the  virus  in  fresh  milk  apparently  suggest 
an  explanation  of  the  sporadic  occurrence  of  some  cases  of  spontaneous 
botulinus  intoxication  in  the  nursing  young  animals.  The  specific  toxic 
character  of  milk  from  apparently  healthy  animals  ingesting  definite 
amounts  of  botulinus  virus  can  be  occasionally  demonstrated  in  guinea 
pigs.  In  one  instance  Dingman*  rather  definitely  recorded  the  possible 
relation  of  the  milk  supply  to  the  occurrence  of  a  disease  in  children 
diagnosed  as  poliomyelitis  (New  York,  1916).  In  three  widely  separ- 
ated boarding  houses  patronizing  the  same  milk  dairy,  cases  of 
poliomyelitis  were  observed.  In  three  other  families  in  the  community 
which  w^ere  furnished  milk  from  the  same  supply  no  cases  of  poliomy- 
elitis occurred.  An  investigation  revealed  the  fact  that  the  milk  was 
always  boiled  by  the  latter  three  families  while  the  former  three 
families  used  the  milk  raw.  If  Dingman  was  dealing  with  cases  of 
botulism,  other  possible  modes  of  transmission  are  obviously  not  ex- 
cluded in  view  of  the  fact  that  botulinus  toxin  and  spores  have  been 
demonstrated  in  other  foods  as  well  as  in  the  larvae  of  the  Lucilia 
caesar  and  in  the  mature  fly. 


^  Eecently,  this  contention  was  confirmed  in  connection  with  an  acute  gastro- 
intestinal disturbance  in  children  from  eating  fig  newtons  in  one  family  and  bread 
in  another  Avhich  upon  examination  were  found  to  contain  B.  botulinus  type  A.  The 
symptoms  were  not  analogous  to  known  cases  of  botulism  in  adult  persons. 

^Dingman,  J.  C.     New  York  State  Journal  of  Medicine,  16,  589.     1916. 


19^1]         B.    BOTULINUS    IN    THE   EXCKETIONS    OF   POLIOMYELITIS    PATIENTS  5 

The  possible  significance  of  the  experimental  findings  in  the  milk 
-  of  lactating  animals  consuming  contaminated  rations,  if  any,  in  rela- 
tion to  the  health  of  the  milk-consuming  public  suggested  the  occur- 
rence of  some  disease  of  a  cryptogenic  etiology  in  man.  The  conjecture 
that  such  a  disease  might  more  often  occur  in  children  than  in  adults 
would  naturally  follow  because  of  the  dietary  difference  or  varying 
tolerance  of  the  two  groups.  A  resume  of  the  literature  on  prevailing 
paralytic  diseases  of  children  with  particular  reference  to  numerous 
reports  on  poliomyelitis  and  the  modes  of  transmission  presents  a 
conception  of  poliomyelitis  which  conflicts  with  the  disease  as  experi- 
mentally produced  and  fails  to  harmonize  with  the  generally  accepted 
ideas  regarding  other  infectious  diseases.  In  this  connection  the 
possibility  of  a  food  transmission  is  not  entirely  disregarded.  These 
and  other  facts  suggested  the  advisability  of  attempting  a  comparative 
study  of  poliomyelitis  in  children  from  the  standpoint  of  pathogenic 
anaerobes,  with  particular  reference  to  B.  botulinus. 

Observations  in  animal  botulism  indicate  that  the  symptomatology 
of  a  botulinus  intoxication  in  children  might  not  be  easily  recognized 
on  the  basis  of  the  syndrome  of  this  intoxication  observed  in  mature 
persons.  In  fact,  there  has  been  no  more  perplexing  problem  in 
animal  botulism  than  the  clinical  diagnosis  of  the  disease,  not  only 
in  different  animal  species,  but  in  the  same  specie  of  different  ages. 
If  this  phenomenon  is  subject  to  interpretation  it  may  be  explained 
on  the  basis  that  the  toxin  may  affect  or  localize  in  different  nerve 
centers  and  thus  induce  various  forms  of  local  paralysis.  In  view 
of  the  fact  that  a  specific  botulinus  intoxication  in  animals  has  been 
clinically  confused  with  acute  bacterial  infections,  rabies,  and  defi- 
ciency diseases,  it  is  even  possible  to  suggest  that  the  acute  and  more 
easily  diagnosed  cases  of  botulism  in  domestic  animals  and  man  con- 
stitute but  one  type  of  the  existing,  yet  unrecognized,  forms  of  this 
disease.  The  syndrome  encountered  in  the  classical  picture  of 
poliomyelitis  as  observed  in  different  patients,  however,  suggested  to 
the  writers  the  possible  presence  of  a  neurotropic  virus  resembling 
the  action  of  botulinus  toxin. 


A  CLINICAL  AND  EPIDEMIOLOGICAL  NOTE  OF  THE 
POLIOMYELITIS  PATIENTS 

Three  of  the  cases  of  poliomyelitis  in  children,  wherein  B.  botulinus 
type  A  was  encountered  in  the  excretions,  were  reported  on  the  follow- 
ing epidemiologic  cards  of  the  Illinois  State  Department  of  Health : 


University  of  Illinois  Bulletin  [November  9, 


Fig.  1. — Patient  154 


19S1]         B.    BOTULINUS    IN    THE    EXCRETIONS    OF   POLIOMYELITIS    PATIENTS 


Patient  154 


ILLINOIS  STATE  DEPARTMENT  OF  HEALTH 


COUNTY 

CITY  OR  TOWNSHIP 

NAME 


DATE  Sept.    12,    1921. 


OUTBREAK   IN  FAMILY 

POLIOMYELITIS 


Years                 MaI<^FemaTe                                            Marfied"SinEl..^Widowcd                     White— Black 
ADDRESS:      STREET                                                                             NUMBER                                                    FLOOR      1                                 ROC 

(Of  Molhcr.  if  minor) 

REPORTED    BV     DP  .       ZOCl  8      D.       LUHlley                  ADDRESS 

„.,,  sept,    13,    1921. 

THE   HOUSE,                                                  OENERAU  CONDITION       PBIT                                                                                            NUM 

BER   OF    FAMILIES           1 

STABLE  NEAR7,VESMNO,       ^66       EXPOSED  OARBA3E.  ETC..   NOTED,  ,  VES)    .  NO,           YeO 

THE  HOME,  GENERAL  CONDITION  (OOODl(BAD>     Pair       PLIES  iVES,    .NO,      YSS           VERMIN  (VES, 

(NO,         No 

THE   PAMILY,  ADULTS       O                                         CHILDREN                  2                          J.                                                               ON  PRE 

MisEs  SINCE     1  month 

C, — ^  years     6 — 10  years      11— 20  years 

DETAILS.  DATES  OP  CONTACT 

INSPECTORS  DIAGNOSIS  Acuto  suterlor  poliomyelitis 

ONSET      DATE   Sept.        12th 

PARALYSIS,  WHEN  FIRST  APPEARED    Sept.       1  3  ,     PARTS   AFFECTED            ISft       8  riD 

GENERAL  SYMPTOMS,  RESPIRATORY           NO                                                                                                            GASTROINTEST 

NAL           No 

TYPE-  1    ABORTIVE                  2  SP  1  NAlV  6  S  3  MENl  NGEAL                  -ICEREBRAL                  LUM  BAR  PUNCTURE 

DATE      "No                                    RESULT 

PRECAUTIONS  OBSERVED,   ISOLATED  (YES,      NO,        YBS                     DEATH          HO                                         FROM 

FOOD  HANDLERS  IN  FAMILY  (YES,    (NO,   REPORT        NO                                  CH 1  LOR' N  ATTEND  SCHOOL  AT 

EXCLUDEoYeS 

REMOVAL  AND  RENOVATION  ORDERED        YeS-SCreenS          ASSIGNEDTO      D  P  .  H  eBry    RO  i  3  ,  BS  1 IC  Vl  1 IS      RETURNED 

Anamnesis 

Sept.     6 — Child  indisposed.     Vomiting  and  pains  in  epigastrium. 

Sept.  10, 11 — Slight  headache. 

Sept.  12 — Headache,  tackache,  pain  in  right  arm.    Sensation  in  left  arm,  described 

as  ' '  worms  crawling  inside  of  arm. ' ' 
Sept.  13 — Left  arm  showed  paralysis  of  long  flexors  and  shoulder  muscles.    Slight 

constipation  relieved  by  mild  cathartic. 


Diagnosis:    Poliomyelitis 

Urine  as  submitted  in  sterile  container  Sep- 
tember 20,  1921,  proved  positive  to  B.  botulinus 
type  A. 


University  of  Illinois  Bulletin 


[Novemher  9, 


PM 


19£1]         B.    BOTULINUS    IN    THE   EXCRETIONS    OF   POLIOMYELITIS    PATIENTS 


Patient  269 


ILLINOIS  STATE  DEPARTMENT  OF  HEAL,TH 
countW 
CITY  oR'VawraSHTV 

NAME  DATg     SOpt .      14  >      1921 


OUTBREAK   IN  FAMILY 

POLIOMYELITIS 


AGESOmOseX         P                      MARITAL  STATE         S 

COLOR      W                           NATIONALITY      D.S/      .                  OCCUPATION 

ADDRESS:     STREET      WOSteni      AVO  ,            NUMBE 

Tlif"^                   FLC^Tt""                            ROOM"'NO°:'6':"°""cAREOFDr.Butler: 

REPORTED    BY     H^O* 

THE    HOUSE:                                                  GENERAL   CONDITION 

Pa"lr"                                                                                      NUMBER   OF    FAMILIES     ,      1      ' 

STABLE  NEAR,  (YESMNO,       flO      ,      EXPOSED  OARBAG 

I.  ETC..   NOTED,   ;yES,    .NO,                    QQ 

THE  HOME,  GENERAL  CONDITION   (GOODl    IBAD,      P 

FLIES   lYES.    (NO,          nO_J     VERM  1  N  ( YES,   (  NO,      'llO 

THE   FAMILY:  ADULTS                    O                            CHILDREN 

1'                                                                                          ON  PREMISES  SINCE     3      ySaTS 

EXPOSURE   TO    INFECTION:  ANY  CONTACT.  DIRECT  OR 

INDIRECT.  WITH  OTHER  CASE?  (YES)   (NO)        ^  DO 

DETAILS.  DATES  OF  CONTACT 

INSPECTORS  DIAGNOSIS  Acutc  aiiterlor 

poliomyelitis                                     onset:  date  9-3-21 

PARALYSIS     WHEN  FIRST  APPEARED      9-9-21 

PARTS  AFFECTEoRight&  left,  upper  &  lower  extremities 

GENERAL  SYMPTOMS     RESPIRATORY             yS3 

gastrointestinal          yes 

TYPE:  .    ABORTIVE                  ^  SP,  NAL  JSB  3  MEN,  NGEAL 

<l  CEREBRAL                  LUMBAR  PUNCTURE     DATE                                                    RESULT 

\           PRECAUTIONSOBSERVEDISOLATED     YES     -NO.          7« 

S                    DEATH                                                            FROM                                                                                                                              ' 

FOOD  HANDLERS  IN  FAMILY     YES.    'NO.   REPORT       HO 

CHILDREN  ATTEND  SCHOOL  AT           DO                                                            EXCLUDED 

REMOVAL  AND  RENOVATION  ORDERED 

ASSIGNEDTO        S  .S  .      WiDBer,        M.n,                                       RETURNED 

Anamnesis 

July    —     Intermittent  attacks  of  diarrhea  and  vomiting. 

Sept.     3 — Child  fell  down  stairs.    Severe  cold  with  purulent  green  nasal  discharge. 

Diarrhea  had  subsided  during  the  two  weeks  preceding  this  date. 
Sept.     5 — Diarrhea,  fever,  attitude  dull.     Malaria  suspected. 
Sept.     6 — Fetid    diarrhea,    containing    mucus.      Spasmodic    twitching    of    facial 

muscles,    neck    stiff;     no    Brudzinski,    negative    Babinski,    respirations 

regular,  lungs  normal,  pulse  140,  temperature  102.2°.     Glands  in  neck 

slightly  enlarged. 
Sept.     9 — Patient  extremely  toxic,  stares  at  ceiling,  irrational  at  times,  abdominal 

breathing  only,  foot  pendulent,  slight  opisthotonos,  temperature  102°. 

Eeluctant  about  moving  lower  extremities. 
Sept.  10 — Paralysis  of  upper  and  lower  extremities. 


Diagnosis:    PoUomyelitis 

Stool  as  submitted  in  sterile  container  Septem- 
ber 26,  1921,  proved  positive  to  B.  botulinus 
type  A. 


10 


University  of  Illinois  Bulletin 


[November  9, 


19^1]         B.    BOTULINUS    IN    THE    EXCKETIONS    OF    POLIOMYELITIS    PATIENTS 


11 


Patient  276 


ILLINOIS  STATE  DEPARTMENT  OF  HEALTH  case 


COUNTY 

CITY  OR  TOWN 

NAME 


POUIOMYELITIS 


ACE       5 

SEX        H 

MARITAL  STATE                  S 

COL 

3R          W 

NAT 

oNALiTv  American 

OCCUPATION 

Yea; 

^L  - 

STREET 

Division                             NUMBE 

'       1737 

FLoor'' 

4tb 

ROOM    NO                           CA 

RE  oFDr. Levin 

I.M.   Levin 

ADDRESS- 

DATE 

THE    HOU 

SE. 

GENERAL   CONDITION 

Poor 

NUMBER   OF    FAMILIES 

about   10 

STABLE  ^ 

EAR7 (VES. 

NO)    .  no             EXPOSED  GARBAGE 

.  ETC.,  NOTED?  ^YE 

Tea 

THE  HOM 

E-  GENERAL 

CONDITION  (GOOD,   ,BAD,    P 

FklEB  (VES,   (N 

3,    yes 

VERMI 

N.vEs,  ,No.   Yes 

2                                   CHILDREN 

1 

ON  PREMISES  SINCE,     2 

months 

E   TO    INFECTION     ANV  CONTACT    DIRECTOR 

NDIRECT.  WITHO 

THERCAS 

E7 .VES 

MO,  ..no 

DATES  ore 

ONTACT 

DR-S  DIAGN 

3SIS    acute  anterior 

poliomyelitis 

ONSET      O 

ATE  97l6/2i 

IS:  WHEN  F 

RST  APPEARED       9/l9/21 

PARTS  AFFECTED 

Lower  left 

extremity 

GENERA 

SYMPTOMS 

fi^sfina-roK^ 

OASTRO 

NTESTINAL 

BORTIVE 

2  SPINAL  SPlBftlNINGEAL 

,4rEREBR«L 

LUN- 

BAR  PUN 

CTURE     DATE            ^^ 

ilOO  cell 

RESULT 

PRECAUT 

IONS  OBSEF 

Hospitalized 

F 

cloudY 

AMILV     VES>    =NO.    REPORT       NO 

CHILD 

F?JN   ATTE 

VD  SCHOC 

L  AT 

LAND  RENO 

NATION  ORDERED 

ASS.GN 

ED  TO 

s.s. 

Winner  M.D. 

RETURNED 

Anamnesis 

Sept.  16— Cheeks  flushed. 

Sept.  17 — Patient  vomiting,  high  fever,  irrational,  grinding  teeth.  Spasmodic 
twitching  of  hands,  constipation,  pain  in  lumbo-sacral  region  and 
posterior  muscles  of  left  leg.  Headache  and  pain  over  left  eye.  Patient 
in  attempting  to  stand  fell  over. 

Sept.  19 — Pupils  dilated,  facial  and  neck  muscles  normal.  Well  marked  posterior 
and  cervical  adenopathy.  Temperature  101°.  Spasmodic  twitching  of 
pectoralis.     Partial  paralysis  of  lower  left  extremity. 


Diagnosis:    Poliomyelitis 

Urine  as  submitted  in  sterile  container  Septem- 
ber 27,  1921,  proved  positive  to  B.  botulinus 
type  A. 


12 


University  of  Illinois  Bulletin 


[Novemher  9, 


Ph  ^ 


P^  fj 


1931]         B.    BOTULINUS    IN    THE    EXCRETIONS    OF   POLIOMYELITIS    PATIENTS 


13 


THE  RELATION  OF  STRAINS  154,  269,  AND  276  TO 
B.  BOTULINUS  TYPE  A 

Ten  days  after  the  urine  and  stool  inoculations  (154,  269,  and  276) 
were  made,  the  cultures  were  tested  for  toxicity  by  feeding  .5  cc  to 
healthy  guinea  pigs.  The  toxic  effect  of  cultures  269  and  276  was 
first  noted  twenty-four  hours  after  feeding.  On  the  second  morning 
the  photographs  shown  in  Figs.  4  and  5  were  made,  and  within  a  few 
hours,  forty-eight  hours  after  the  feeding  of  the  toxin,  the  pigs  were 
dead.  The  prostrate  condition  as  observed  in  these  animals  is  typical 
of  botulinus  intoxication  in  guinea  pigs.  Death  in  animals  so  aftectea 
generally  follows  in  a  few  hours. 

The  lethal  character  of  the  cultures  isolated  from  specimens  154, 
269,  and  276  to  type  A  botulinus  was  demonstrated  by  injecting  ex- 
posed guinea  pigs  with  antitoxin.  The  results  encountered  in  culture 
154  are  identical  with  those  obtained  from  culture  276.  Culture  269 
produces  a  very  mild  extra-cellular  toxin.  On  October  4,  1921, 
three  guinea  pigs  were  given  .5  ec  of  broth  culture  154  via  the  mouth. 
Simultaneously  pig  76  was  given  subcutaneously  25  units  of  botulinus 
antitoxin  type  A,  and  pig  780  was  given  subcutaneously  25  units  of 

Table  1 


G.P. 

Toxin  10-4-21 

Antitoxin  10-4-21 

Eesults 

76 

154 — .5  cc  per  orem 

25  units  botulinus  anti- 
toxin type  A, subcutaneously 

Remained  healthy 

780 

154 — .5  cc  per  orem 

25  units  botulinus  anti- 
toxin tyi^e  B,  subcutaneously 

Dead  10-5-21 

308 

154 — .5  ec  per  orem 

Control 

Dead  10-5-21 

Fig.  6. — Guinea  Pigs  76,  780,  and  308,  Showing  Protective  Character  of 
Type  A  Antitoxin.    Photograph  Taken  Twenty-four  Hours  after  Treatment 


14 


University  of  Illinois  Bulletin 


[Novemier  9, 


botulinus  antitoxin  type  B.  Pig  308  was  left  as  a  control.  The  treat- 
ment as  administered  and  the  result  are  presented  in  Table  1.  In  Fig. 
6  is  shown  a  photograph  of  the  guinea  pigs  taken  twenty-four  hours 
after  the  treatment. 

The  immunologic  relation  of  culture  154  to  culture  276  was  estab- 
lished by  a  similar  procedure  wherein  the  protective  character  of 
botulinus  antitoxin  type  A  was  observed.  The  toxin  and  antitoxin 
were  administered  as  indicated  in  Table  2.  As  shown  in  this  same 
table,  the  pig  which  had  been  injected  with  botulinus  antitoxin  type  A 
was  the  only  one  of  the  three  which  survived  at  the  end  of  twenty-four 
hours.     See  Fig.  7. 

Table  2 


G.P. 

Toxin  10-21-21 

Antitoxin  10-21-21 

Eesults 

856 

276 — .5  ee  per  orem 

25  units  botulinus  anti- 
toxin type  A, subcutaneously 

Eemained  healthy 

725 

276 — .5  cc  per  orem 

25  units  botulinus  anti- 
toxin tyx^e  B,  subcutaneously 

Dead  10-22-21 

124 

276 — .5  cc  per  orem 

Control 

Dead  10-22-21 

Fig.  7. — Guinea  Pigs  856,  725,  and  124,  Showing  Protective  Character  of 
Type  A  Antitoxin.    Photograph  Taken  Twenty-four  Hours  after  T'reatment 


The  toxogenic  character  of  strain  276  for  monkeys  was  observed 
by  feeding  the  contents  of  one  glucose  agar  shake  culture  to  a  healthy 
ringtail  monkey  (white-throated  Sapajou  or  Capuchin,  Cehus  liypo- 
leucus,  No.  734).  The  culture  was  fed  at  11  a.m.,  October  22,  and  the 
animal  then  placed  in  a  separate  cage  and  fed  wholesome  food.  Pro- 
found toxic  symptoms  were  observed  at  7  a.m.,  October  24.  At  this 
time  the  monkey  was  able  to  stand  erect  for  only  a  moment.  An 
opossum-like  attitude   (Fig.  8)   was  assumed  as  the  pendulous  head 


16 


University  of  Illinois  Bulletin  yNovember  9, 


Fig.  8 


Fig.  9 


1931]         B.    BOTULINUS   IN    THE    EXCRETIONS    OF   POLIOMYELITIS    PATIENTS  17 


Fig.  10 


Fig.  11 

Figs.  8-11. — Symptoms  Observed  in  Monkey  734  Forty-five  Hours  after 

Exposure 


19^1]         B.    BOTULINUS    IN    THE    EXCRETIONS    OF   POLIOMYELITIS    PATIENTS  19 

and  neck  (Figs.  9  and  10)  flexed  on  the  forearms.  When  placed  in  a 
standing  position  with  the  head  erect,  the  animal  fell  over  and  assumed 
a  lateral  decumbent  position  (Fig.  11).  The  respirations  were  shallow 
and  irregular.  Following  exertion,  dyspnea  and  mouth-breathing  were 
pronounced.  Complete  prostration  and  coma  terminated  in  respira- 
tory paralysis  and  death  at  11  a.m.,  October  24. 

SUMMARY 

Approximately  two  hundred  specimens  of  body  excretions  includ- 
ing feces  and  urine  as  well  as  throat  swabs  from  some  eighty  cases 
of  poliomyelitis  are  being  examined  in  the  Laboratory  of  Animal 
Pathology  and  Hygiene  of  the  University  of  Illinois,  for  pathogenic 
anaerobes.  One  stool  and  five  urines  as  submitted  from  widely  sepa- 
rated spontaneous  cases  of  this  disease  in  the  state  of  Illinois  have 
proved  positive  to  B.  botulinus  type  A.  The  syndrome  in  each  of 
the  six  cases  was  regarded  as  typical  of  poliomyelitis  by  the  attending 
physician. 

Since  other  possible  factors  have  not  been  considered  in  the  pre- 
liminary studies,  the  specific  relation  of  -B.  botulinus  type  A  to 
poliomyelitis-like  diseases  is  only  a  matter  of  conjecture  at  this  time. 
Furthermore,  the  number  of  cases  of  poliomyelitis  in  children  included 
in  this  phase  of  the  investigation  is  too  small  to  permit  the  conclusion 
that  B.  botulinus  is  an  etiologic  factor.  However,  the  possibility  of  a 
botulism  transmission  thru  milk  is  experimentally  established  in  ani- 
mals, and  if  the  human  organism  reacts  similarly,  milk  may  be  a 
factor  tho  the  possibility  of  transmission  thru  other  foods  merits  con- 
sideration. The  role  of  flies  or  other  insects  which  might  mechanically 
contaminate  food,  is  not  excluded  in  the  preliminary  studies.  In 
view  of  these  facts,  as  well  as  of  the  neurotropic  character  of  botulinus 
toxin,  it  seems  advisable  not  to  overlook  the  possible  relation  which 
may  exist  between  some  cases  of  poliomyelitis  in  children  and  a  spe- 
cific botulinus  intoxication,  altho  the  occurrence  of  distinct  and  sep- 
arate diseases  in  children,  diagnosed  as  poliomyelitis,  is  not  excluded 
in  this  connection. 

The  fact  that  B.  botulinus  type  A  has  been  encountered  in  the 
excreta  of  six  convalescent  poliomyelitis  patients  suggests  the  advisa- 
bility of  continuing  the  investigations  until  the  saprophytic  and  toxo- 
genic  character  of  this  microorganism  in  nature  is  definitely  established 
with  special  reference  to  its  presence  in  the  excretions  of  normal  chil- 
dren and  of  patients  suffering  from  a  paralytic  syndrome. 


5t.  Clair  Mo. 
Marshall.  Mo. 
Clarksburg,  fia 
Kansas  City,  Mo. 
Indianapolis.  Ind. 
Battk  Creek,  Mich. 
Grand  Bapids,  Mich. 
Wash inqfon.  DC.  " 
Freehold,  N.J.  ' 


Epidemiologic  Map  II 

Total  number  of  contaminated  feeds  or 
outbreaks  of  botulism  in  man  and  animals 
confirmed  by  baeteriologie  and  immunologic 
examinations  in  the  Laboratory  of  Animal 
Pathology  and  Hygiene,  University  of  Illi- 
nois, Sept.  1,  1920,  to  Sept.  1,  1921.  In 
Illinois,  149.    Outside  of  state,  9. 


20 


Epidemiologic  Map  III 

Swine  botulism  confirmed  by  bacteriologic 
and  immunologic  examination  in  tlie  Labora- 
tory of  Animal  Pathology  and  Hygiene,  Uni- 
versity of  Illinois.  Sept.  1,  1920,  to  Sept. 
1,  1921. 


21 


Epidemiologic  Map  IV 

Outbreaks  of  avian  botulism  confirmed  by 
bacteriologie  and  immunologic  examinations 
in  the  Laboratory  of  Animal  Pathology  and 
Hygiene,  University  of  Illinois.  Sept.  1, 
1920,  to  Sept.  1,  1921. 


22 


Indiana 

lov/a 

Kentucky 

Minnesota 

Missouri 

Washington.  DC-  Z 


Epidemiologic  Map  V 

2505  specimens  submitted  to  the  Labora- 
tory of  Animal  Pathology  and  Hygiene,  Uni- 
versity of  Illinois,  for  bacteriologie,  path- 
ologic, and  seriologic  diagnosis.  Sept.  1, 
1920,  to  Sept.  1,  1921. 

23 


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